Member Advocate II

• Act as an advocate for members and liaison between the Health Plan and providers to ensure availability and access to care
• Establish a community presence and promote member education
• Identify and resolve systemic barriers limiting access to appropriate care
• Receive and respond to member complaints and formal grievances
• Serve as primary contact and liaison between member advocacy groups, human services agencies, providers and State entities
• Evaluate member qualifications for better benefit entitlement programs
• Conduct field trainings and face-to-face meetings with providers, members and community agencies
• Report results to senior management and recommend needed resolutions
• Recommend internal process changes to improve provider and member satisfaction
• Advise the Health Plan on contract compliance in delivery of covered services
• Perform training, orientation and coaching for performance improvement
• Educate members and providers on benefits-related policies and procedures, website promotion and education
• Investigate and resolve access and cultural sensitivity issues
• Participate in local community coalitions
• Update and revise educational materials as appropriate
• Perform other duties as assigned
• Comply with all policies and standards

• Associate’s degree or equivalent experience
• 3+ years of public relations experience
• Experience working with diverse populations
• Knowledge of health care, managed care, Medicare or Medicaid
• Good driving record
• Ability to travel
• Valid driver’s license
• Claims billing/coding knowledge preferred
• Insurance producer license preferred
• Must reside in Wisconsin;
  Milwaukee-area residence highly preferred

Demonstrates expertise in member advocacy, community engagement, and health care compliance, with a strong focus on resolving access issues and improving member satisfaction. Proficient in educating diverse populations on benefits-related policies and conducting training for providers and community agencies.